House of Commons - Work and Pensions

Select Committee on Work and Pensions Fourth Report

16 OCCUPATIONAL HEALTH

255. The HSC recognises that tackling occupational ill-health is a significant challenge.[433] A number of issues arose in the course of our inquiry: the adequacy of data on the extent and nature of occupational ill-health, 'emerging' risks such as those associated with passive smoking and occupational stress, HSC/E's approach to tackling the issue, the availability of occupational ill-health and the role and nature of inspection in this area.

Health data

257. The regulations require employers to report all cases of a defined list of 47 occupational diseases occurring among their employees where they receive a doctor's written diagnosis and the affected employee's current job involves the work activity specifically associated with the disease.[435] Comparison of these figures with those for disablement benefit for the corresponding DWP prescribed diseases suggests that there is still substantial under-reporting under RIDDOR, particularly for diseases with long induction periods (for example, the pneumoconiosis and occupational cancers). In addition, poor access to occupational health services and compromised knowledge of occupational health in primary care is likely to result in under-diagnosis of occupational disease.

258. At present there are no data-collection systems by which HSE inspectors and Environmental Health inspectors can locate cases of occupational morbidity. The RIDDOR system is discredited as a method of locating cases (there is likely to be an inverse relationship between use of the system and need - only well-managed firms will use it).[436] For example, Mr Simon Pickvance of the Sheffield Occupational Health Advisory Service (SOHAS) told us that in a Yorkshire city of 200,000 people, one of the enforcement agencies received just one case of occupational illness under RIDDOR last year.[437] There is no system of data collection through the health care system though primary care occupational health projects that could provide this in the future the Sheffield scheme sees 1200 patients with occupational health problems for the first time each year.

259. However, HSE is introducing a new workplace survey which, Mr Gareth Williams of the Department for Work and Pensions told us 'will give us statistics of National Statistics quality on workplace ill-health in order that we can get a better handle on both the starting position and the causes and principal contributory factors, so as to improve our evidence base'. In addition, HSE has secured funding to pilot a two-tier workplace survey to improve its understanding of accident and ill-health levels in the construction industry.[438] The Committee welcomes steps being taken by HSE to improve our understanding of the nature and extent of the problem.

HSC/E's approach

260. HSC issued a long-term occupational health strategy in 2000. This included targets to, by 2010:

Achieve a 20% reduction in the incidence of work-related ill health;

A 20% reduction in ill health to members of the public caused by work activity;

A 30% reduction in the number of work days lost due to work-related ill health

Everyone in employment but off work due to ill health or disability to be made aware, of opportunities for rehabilitation into work as early as possible; and

Everyone currently not in employment due to ill health or disability is, where necessary and appropriate, made aware of and offered opportunities to prepare for and find work.

261. HSC's current strategy indicates that a reasonable job has been done on safety issues, 'but there is still a huge job to do on health'.[439] It sees the need for a 'more strategic and partnership-based approach.' This will include creating partnerships to develop the provision of occupational health and safety support, raising awareness of and stimulating demand for these services and placing a greater emphasis on rehabilitation. [440]

262. Dr Kit Harling of NHS Plus told the Committee that while HSE had now recognised the scale of the problem, the next step was to move to 'actually implementing some positive policies that are going to help the delivery of occupational health care in its broadest sense'.[441] He argued that the fact that health and safety have been linked over many decades has led to a false assumption that the systems for managing the risk of accidental injury and occupational disease are similarly identical.[442] His view was that important differences emphasised the need for a different approach. Firstly, occupational safety focuses on preventing injuries through preventing accidents, whereas occupational illness may be the cause of some long-term feature of a normally operating system and there is no 'instantaneous cause'. Secondly, occupational illness often has various causes. Thirdly, it is rare that occupational illnesses are exclusively attributable to workplace factors.

263. Several witnesses pointed out that the HSE cannot manage the risks of occupational illness on their own or in isolation.[443] Dr Kit Harling suggested that what was needed was a multifaceted approach based on the development of partnership working.[444] He argued that as HSE itself was not likely to be able to do all the multi-disciplinary parts of the job that need doing, it should adopt a leadership role, looking at how the different components can work together.[445] In addition to its traditional partners, it needs effective links to the expertise of the health community - primary care organisations, secondary care, public health, local authorities and the private & voluntary sector. Mr Simon Pickvance of SOHAS, on the other hand, was concerned that a 'partnership' approach might not deliver:[446]

"I think 'partnership' just sounds like some meetings at which people talk to one another, it does not sound like the kind of concrete action that is needed. I have a sense of urgency about this. I see people who are losing their jobs day by day. I have done this job for 25 years and have seen very little change. In many areas, things have got a lot worse… Partnership is not enough for me, there has got to be a concrete co-ordination of effort."

264. He argued that the problems of occupational ill health were difficult but not intractable:

"I would have thought that if you wanted to achieve those targets you would identify the workplaces in your area that were creating the problems and you would address each one asking what is going to achieve this: 'If the process line works at a rate at which people get injured, something big has got to change, some big investments are going to have to go in….I think we have to face up to how big these tasks are if we are serious, otherwise we might as well go home and say, 'health and safety is an area we cannot handle, society cannot deal with it."

Availability of occupational health expertise

265. Improving the coverage of occupational health support is a crucial part of the strategy to ensure that employers have access to the advice and support they need to protect their employees from health risks (see Chapter 15). However, coverage of occupational health support is low and the Government is only now conducting and evaluating pilots. Furthermore, reduced funding for EMAS, especially at a time of growing awareness of the scale of emerging risks, is said to have considerably reduced HSE's capacity to provide advice on occupational health issues. Furthermore, a range of witnesses to the inquiry suggested that reductions in HSE's in-house expertise on health issues sent out the wrong message.[447] EEF, the manufacturers' organisation, said:[448]

The occupational health specialism within HSC/E - EMAS - is significantly under-resourced particularly [since] a major part of the future strategy concerns itself with health-related issues. To be credible in the agenda they will need to have access to high quality occupational health advice.

266. The Faculty and Society of Occupational Medicine was particularly concerned at the demise of the post of Chief Medical Officer.[449]The Committee shares HSC's concern that there is a 'huge job' to do on health. It is concerned, therefore, that reduction in HSE's in-house expertise has raised major questions as to its capacity to show leadership on the issue. We recommend the Government reviews the resources available for this work to enable the HSE to fulfil this growing role.

The role and nature of inspection

267. A number of organisations (such as Prospect and TUC) are critical of a lack of proactive enforcement action by HSE with regard to occupational health issues.[450] The TUC, for example, points out that in 2002/03, the regulations most frequently used for securing a conviction were construction, work equipment and gas safety regulations (leading to over 85 convictions). In contrast, only one person was successfully prosecuted under the noise regulations and one under the manual handling regulations, despite 'the epidemic of back, pain, stress, hearing loss and RSI that we have seen in recent years.'[451]

268. Figures provided to the Committee by HSE show that in 2003/04, there were 14 enforcement notices under the Health and Safety (Display Screen Equipment) Regulations 1992, 243 under the Manual Handling Operations Regulations 1992 and 202 under the Noise at Work Regulations 1989.[452] This compares to some 13,263 enforcement notices issued by HSE in 2002/03.[453] Research also suggests that prosecution may be under-used for health issues.[454]

269. It should also be noted that health problems such as musculo-skeletal disorders and stress are connected to the way in which work is organised. The 'principles of prevention' set out in existing legislation (which refer to adapting work to the worker and avoiding repetitive and monotonous work) should, if applied effectively, help to reduce such problems.[455] Yet, just 103 relevant enforcement notices were issued in 2002/03[456].

270. Evidence to the Committee suggested a low level of enforcement action in relation to stress, one of HSE's priority programme areas and one which evidence to the inquiry suggests employers find difficult to tackle. A small survey of social services departments conducted by the Employers' Organisation for Local Government (EO) found that while 10 out of 14 respondents were taking action to reduce stress, in only 2 cases was the action considered to be effective. [457] A survey of lab workers by Amicus found that stress-related illnesses were the most frequent cause of serious work-related ill health among lab workers[458]. Over two-thirds (69%) of respondents thought their employer took the issue seriously but only 4.6% thought their employer was taking adequate steps to deal with the issue. Despite this, there was only one case of a department or institute that had been reprimanded by the HSE for stress problems in the last three years. (The NHS Confederation and the EO did, however, report that HSE was helping to encourage employer action on stress, with the EO pointing to a 'rolling programme of auditing of local authorities for their stress management techniques, practices and procedures.' [459])

271. Asked about the low levels of enforcement action in this area, the Minister emphasised the importance of ensuring employers had the advice and guidance they needed:[460]

'Before we put emphasis on enforcement for health, we need to ensure that there is good information and advice out there being given to employers before we then require them to implement it. The HSE is doing this, it is running a number of pilots which will then be evaluated.'

272. Coverage of occupational health support for employers is low (see chapter 15) and developing this is a crucial part of HSE's strategy in the longer-term. However, in the meantime, there must be cases in which enforcement action is appropriate. The Sheffield Occupational Health Advisory Service (SOHAS), for example, told the Committee that there were firms in Sheffield that have caused substantial health problems for years.[461] Furthermore, it seems that enforcement can be effective in prompting action in this area. Mr Julian Topping of the Department of Health told us that the improvement notice issued on West Dorset General Hospitals NHS Trust in relation to stress had helped ensure that HSE guidance on stress had been 'picked up very well by people across the NHS'[462] The extent of occupational health problems, such as musculoskeletal disorders and stress, suggests that enforcement action on these issues could be increased substantially, with beneficial results.

273. The question is then whether HSE is able to identify cases where action needs to be taken, whether it is sufficiently resourced to do this and whether its inspectors are equipped for the job. SOHAS argued that a major problem is that enforcement agencies lack the means to achieve their targets.[463] In order to play a major role, they must be able to identify where cases are occurring, have the intervention methods that they need to bring about change in the workplace and the monitoring systems to make sure that change has occurred.

274. In terms of identifying cases of occupational ill-health that need investigating, SOHAS pointed out that employment insecurity and confidentiality issues limit the data collected at workplace level that enforcement agencies could use.[464] SOHAS perceived a reluctance on the part of employees to reveal health problems to managers because of the risk to their jobs and considered that greater employment protection than that provided by existing employment and disability legislation was needed. It suggested that non-legal solutions might include the development of secure communication systems between workers and enforcement agencies, or the development of alternative sources of data collection not currently available.

275. In terms of identifying the kinds of premises that would benefit from a proactive inspection, CoSLA pointed to a need to review the criteria used by local authorities to enable this to be done.[465] It argued that in doing this, increased emphasis needed to be given to health issues which had traditionally 'not featured too highly' in a local authority context and account should be taken of initiatives currently being undertaken by HSE on stress in the public sector and in call centres.[466]

276. SOHAS argues that inspection systems fall down when it comes to looking for occupational health problems and their causes. Missing guards and helmets are obvious, occupational stressors, or an assembly line speed that is too fast or a bench that is the wrong height for some members of staff, are not. At the very least much more probing and time-consuming inspection techniques would be required. SOHAS also points to the difficulty of defining satisfactory compliance outcomes for inspection visits and argues that this is likely to be one reason for the small number of prosecutions reported each year for failure to comply with health related regulations.

277. The Committee recommends that inspectors should have the resources that they need to be able to identify health issues, recommend remedial action to be taken by employers and define satisfactory outcome measures. Resources are also required to enable proactive research work to be done on combating newly emerging risks, like passive smoking. The risk assessment criteria should be reviewed to ensure they are able to identify workplaces where occupational health risks are high. The results of this review should be published by 1 October 2005.

PASSIVE SMOKING

278. Analysis by Professor Konrad Jamrozik of Imperial College found that every week a worker in the hospitality industry dies from passive smoking and that environmental tobacco smoke in the workplace generally, caused about 700 deaths each year in the UK.[467] In the Republic of Ireland, a ban on smoking in the workplace came into effect in March 2004.[468] In Great Britain, on the other hand, there has been little progress. HSC published proposals for an Approved Code of Practice (ACoP) in September/October 2000. This recommended that every employer should have a smoking policy - this could be to ban smoking, but the concept of reasonable practicability meant other measures could be looked at, such as restricting the amount of time people had to work in smoky areas.[469] However, Mr Bill Callaghan told us the debate had since moved on, and was now "much more a public health issue". EEF, the manufacturers' organisation, argued that the workplace had a role to play but should not be in the vanguard of changing social policy. The same restrictions on smoking should be 'placed on the general public at the same time'.[470] A White Paper on improving health, to be published in autumn 2004, will outline how the Government intends to tackle problems such as smoking.[471] The Committee recommends that the Government review the experience of the ban on smoking in the workplace recently introduced in Ireland. Measures to deal with passive smoking in the workplace should be included in the forthcoming White Paper on improving health.

Rehabilitation

279. Each year, some 3,000 people are forced to give up work because of prolonged illness, injury or disability.[472] 80% do not return to work within 5 years and many never work again. Support for rehabilitation is key to achieving the aim of reducing the number of working days lost due to injury and ill health. DWP itself is considered to be doing valuable work to support rehabilitation.[473] Since April 2003, DWP's Job Retention and Rehabilitation pilot has been testing the effectiveness of different ways of helping people who have been off work because of sickness, injury or disability to get back into or remain in work. At present there is too little data to enable conclusions to be drawn. DWP has also, as part of its review of Employers Liability Insurance, published a discussion document on Developing a Framework for Vocational Rehabilitation.[474] The aim is to describe the scope of vocational rehabilitation, present an overview of current provision, highlight the basic principles and approaches taken, summarise the current evidence base on successful interventions, introduce new work and highlight new areas of analysis to consider. The intention is to make better use of existing resources rather than to establish a comprehensive national service.

280. Key issues arising in the course of evidence to the inquiry were how to encourage employers to do more and whether this should be by introducing statutory requirements or through Employer's Liability insurance.

281. In some other countries, employers are under certain legal obligations regarding rehabilitation. For example, in New South Wales in Australia, employers are required to appoint workplace rehabilitation co-ordinators.[475] In the Netherlands and Sweden, they are required to develop rehabilitation plans. Organisations such as the TUC argue that in Great Britain there should be a legal requirement for employers to have a policy framework on rehabilitation in place.[476] Action Point 31 of Revitalising stated that HSC should consult on whether the duty on employers to ensure the continuing health of employees, including action to rehabilitate where appropriate, can be usefully strengthened. For example, it notes that 'organisations might be required to set out their approach to rehabilitation within their health and safety policy.' In the absence of legislative opportunity, however, the job retention and rehabilitation agenda is being taken forward by HSE, working in partnership with DWP and the Department of Health.'[477]

282. On the question of the potential role for the insurance industry, the Committee saw, on its visit to Spain, some interesting work being done by the social insurance organisations, the 'Mutuas de Accidentes'. These provide financial support to those off work due to occupational injury or ill health and also provide medical services, support for rehabilitation and advice on prevention.

283. Revitalising emphasised the potential role of insurance in motivating employers to rehabilitate workers.[478] The Association of British Insurers (ABI) told us that insurers in the UK do play a role (particularly in Motor and Employer's Liability insurance environments).[479] However, this is limited and inconsistent - only around 8% of those Employer Liability insurance claimants that would benefit from rehabilitation actually receive it. A reason for this, in ABI's view, is that insurers are only involved in a small proportion of workplace accidents. Furthermore, because the process of settlement is adversarial and lengthy, it can often be too late to make an effective rehabilitation offer because of deterioration in, or chronicity of, the claimant's condition. In addition employers' fear of being blamed for ill-health can act as a barrier to this sort of action.[480] Some insurers have offered no-fault rehabilitation services, but found smaller employers reluctant to invest without better understanding the costs and benefits.

284. The ABI told us that insurers could and should play a role in this and already do so to a limited extent. However, it argued that 'there needs to be recognition that other stakeholders, including Government and employers, would benefit substantially and should bear part of the cost. It estimates that rehabilitation could save 10-40% of the cost of compensation and that comprehensive rehabilitation could save the taxpayer around £1.2 billion a year in reduced benefit payments and higher tax revenues.

285. A number of organisations pointed to the importance of ensuring that the recent emphasis on rehabitation does not detract from work that needs to be done on the prevention side. SOHAS' work in Sheffield and experience in the Netherlands (when pressure came on to reduce the number of disability claims) showed that it 'sucked all the energy out of prevention, so what were supposed to be prevention services became rehabilitation services.'[481] Prevention needs to be protected. Capacity for rehabilitation also needs to be increased. [482]

286. The Committee recommends that HSC reviews international evidence on the efficacy of requiring employers to set out their approach to, and provision of, rehabilitation to determine whether lessons can be learned and introduced in the UK The results of the review to be published by 1 October 2005.

433 HSC (2004), Strategy for workplace health and safety in Great Britain to 2010 and beyond, Sudbury: HSE Books Back

434 HSC, National Statistics (2003), Health and Safety Statistics Highlights 2002/03. Sudbury: HSE Books Back

435 www.hse.gov.uk/statistics Back

436 Volume III (No. 44) Back

437 Volume III (No. 44) Back

438 Volume II (Ev 150, Q585), National Audit Office (2004), Improving health and safety in construction industry, HC 531 Session 2003-2004 para 1.11 Back

439 Volume III (No. 36) Back

440 HSC (2004), Strategy for workplace health and safety in Great Britain to 2010 and beyond, Sudbury: HSE Books Back

441 Volumr II (Ev 95, Q359) Back

442 Volume III (No. 55) Back

443 Volume III (Nos. 55 and 57) Back

444 Volume II (Ev 95, Q359 and 361) Back